1326655101 NPI number — PROACTIVE PHYSICAL THERAPY LLC

Table of content: DR. MICHAELA ELIZABETH LEFFLER PHARMD (NPI 1447611983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326655101 NPI number — PROACTIVE PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROACTIVE PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326655101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9320 GRAND CORDERA PKWY STE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80924-7011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-535-2757
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 WOODMOOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONUMENT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80132-9057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-535-2757
Provider Business Practice Location Address Fax Number:
719-535-2767
Provider Enumeration Date:
09/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RECTOR
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-535-2757

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000161434 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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